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Achdiat PA, Suwarsa O, Hidayat YM, Shafiee MN, Dwiyana RF, Hindritiani R, Sutedja E, Pudjiati SR, Hilmanto D, Dhamayanti M, Parwati I, Maharani RH, Sutedja EK, Avriyanti E, Yunitasari. Efficacy and Safety Profile of Tuberculin Protein Purified Derivative Injection As Immunotherapy For the Treatment of Cutaneous and Anogenital Warts: A Review Article. Immunotargets Ther 2024; 13:123-150. [PMID: 38476374 PMCID: PMC10929246 DOI: 10.2147/itt.s446938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Various treatments available today for anogenital and cutaneous warts have limitations, including time-consuming, challenging to perform, and the risk of scarring. A new treatment using tuberculin purified protein derivative (PPD) has been developed, which is expected to generate cellular immunity against HPV. Objective To assess the evidence for the efficacy and safety of PPD treatment for cutaneous and anogenital warts. Materials and methods A literature search was performed with the keyword-based search on digital libraries, including the National Library of Medicine, Cochrane Controlled Register of Trial, and Google Scholar, using the following terms: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, and tuberculin purified protein derivative. Original studies on treating cutaneous or anogenital warts with PPD were included. The results were 47 clinical trials and 4 case reports. Most of the research was done in countries with common Mycobacterium tuberculosis infection. The treatment showed good efficacy. Comparative studies showed that the treatment has similar efficacy with other immunotherapies. No significant side effects were reported, with evidence of the safety use on the pregnant population. Conclusion Based on good efficacy and safety, PPD can be considered an alternative therapy, especially in countries where tuberculosis is frequent.
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Affiliation(s)
- Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Yudi Mulyana Hidayat
- Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Mohamad Nasir Shafiee
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Reti Hindritiani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Satiti Retno Pudjiati
- Department of Dermatology and Venereology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dany Hilmanto
- Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Pediatric, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Meita Dhamayanti
- Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Pediatric, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Ida Parwati
- Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Retno Hesty Maharani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Eva Krishna Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Erda Avriyanti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Yunitasari
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Awad SM, Gomaa AS, Hassan HA, Tawfik YM. Efficacy of Cryotherapy Combined With Intralesional Purified Protein Derivative (PPD) Versus Intralesional PPD Monotherapy in the Treatment of Multiple Common Warts. J Cutan Med Surg 2023; 27:117-125. [PMID: 36705474 DOI: 10.1177/12034754231152224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Intralesional antigen immunotherapy represents a promising therapeutic approach for the treatment of different types of warts, particularly if multiple and/or recalcitrant. AIM to investigate the efficacy and safety of combined cryotherapy with intralesional purified protein derivative (PPD) immunotherapy in the treatment of multiple common warts. METHODS Fifty patients were randomly divided into two groups (25 patients each): Group A: receiving intralesional PPD immunotherapy for the largest wart, while group B: receiving cryotherapy for all warts plus intralesional PPD for the largest wart. Treatments were performed every 2 weeks for a maximum of four sessions. Photographs were taken at baseline and at each visit and clinical response was evaluated by the reduction in number and size of warts. Adverse effects were recorded. RESULTS There was a significant reduction in size and number of warts in both groups (P < .001), with no significant difference between the two groups. Complete clearance of the lesions was observed in 48% of patients in group A and 44% in group B (P = .39). Higher rates of near complete/complete response were achieved after fewer sessions (2, 3 sessions) in group B (P = .002). Blistering was common after cryotherapy. Higher rate of hypopigmentation was noticed after combined treatment than after PPD monotherapy (56%, 8% respectively; P < .001), which resolved gradually. CONCLUSION Both intralesional PPD alone and combined cryotherapy with PPD are safe and effective in clearing of common warts. Cryotherapy may be a successful adjunct to intralesional PPD immunotherapy that helps in reducing the number of treatment sessions.The study protocol was registered at ClinicalTrials.gov with ID: NCT04288817.
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Affiliation(s)
- Sara M Awad
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed S Gomaa
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hiba A Hassan
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yasmin M Tawfik
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Korsa HHA, Nashaat HAH, Halim HM, Atwa MA, Mahmoud Marie RES. Interleukin-18 serum level before and after intralesional immunotherapy with tuberculin purified protein derivative in patients with cutaneous and genital warts. J Cosmet Dermatol 2022; 21:7035-7042. [PMID: 36059258 DOI: 10.1111/jocd.15358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Several studies demonstrated the efficacy of intralesional purified protein derivative (PPD) immunotherapy in warts eradication. Nevertheless, the precise induced immune mechanisms are undetermined. Injected PPD is hypothesized to induce a delayed hypersensitivity reaction associated with cytokines release. Interleukin (IL)-18 has a major role in defense against viral infection via inducing interferon-γ release from T-helper 1 and natural killer (NK) cells. Moreover, IL-18 triggers Fas ligand expression on cytotoxic T cells and NK cells enhancing their cytotoxicity against virally infected cells. AIM The aim of this study was to assess the role of IL-18 in the response to intralesional PPD injection in patients with warts. METHODS The study included 25 patients with warts and 25 HCs. Patients underwent PPD skin test, and only patients with positive tests were included and received intralesional PPD injections starting 72 h after the test then every 2 weeks until wart clearance or a maximum of 3 sessions. Serum IL-18 level was measured via enzyme-linked immune-sorbent assay in patients (pre-treatment and 2 weeks after the last injection) and HCs. RESULTS After 3 sessions of injection, six (24%) patients were designated responders, nine (36%) patients showed partial response, and 10 (40%) patients were designated non-responders. Serum IL-18 level, post-treatment, was significantly higher than pre-treatment level (p = 0.025) and level in HCs (p = 0.036). Furthermore, the post-treatment level was significantly higher in responders than non-responders (p = 0.025). CONCLUSION IL-18 is probably implicated in the immune mechanisms induced by PPD injection that cause eradication of warts.
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Affiliation(s)
- Hadeer Hazem Abo Korsa
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Halim Maher Halim
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mona A Atwa
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Radwa El-Sayed Mahmoud Marie
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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